NADD - An association for persons with developmental disabilities and mental health needs

From the NADD Bulletin Volume X1 Number 1

Breaking the Cycle of Environmental Health Disparities

Leslie Rubin MD, President, Institute for the Study of Disadvantage and Disability; Medical Director, The Team Centers, Chattanooga, TN; Co-director, Southeast Pediatric Environmental Health Specialty Unit, Emory University; Visiting Scholar, Department of Pediatrics, Morehouse School of Medicine, Atlanta GA

None of us is inseparable from our environment. We are all clearly products of both our genetic endowment and the environment in which we grow up and in which we live. Environmental factors are not only physical or chemical, but are also social and economic. In this day and age we cannot ignore the major debate on climate change and the impact of global warming on life on our planet Earth. Although that debate is beyond the scope of this article, our awareness of the microcosm and macrocosm of our environments will help us to better understand and then to better affect positive change for us, for our children and our children’s children and fellow human beings and fellow living creatures.

At the 24th Annual NADD Meeting in Atlanta, Georgia, the two keynote speakers addressed issues of Environmental Health and how these relate to Developmental Disabilities and the frequently associated behavioral and emotional issues. Dr. Ted Schettler, MD, MPH, co-author of In Harm’s Way: Toxic Threats to Child Development (Schettler, Stein, Reich, Valenti & Wallinga, 2000), spoke on the interaction between genetics and our environment and on the way in which the environment can affect not only child growth and development but also adult health and performance. Dr. John Lutzker, PhD, co-author of Ecobehavioral Family Interventions in Developmental Disabilities (Lutzker & Campbell, 1994), spoke about his research on how the social and economic aspects of family function affect child health, safety, and development.

Lead Toxicity

Lead is the prototype of environmental toxins that cause neurological sequelae. At high levels, lead can cause acute severe and potentially fatal encephalopathy. At low levels lead can adversely affect cognitive and intellectual functioning as well as causing learning and behavior problems; more significantly, the neurotoxic effects of lead can be permanent. In decades past, lead was pervasively present in many products, particularly in paints and gasoline. Since the 1970’s advocates for children’s health have been successful in assuring the elimination of lead from these products. Despite this, we have recently become aware of toys from China contaminated by lead paint – alerting us to the fact that we should never drop our vigilance.

More recently, compelling evidence has come to light that lead burden and its neurodevelopmental and neurobehavioral consequences on social function and social success are disproportionately prevalent among poorer populations who live in older and more dilapidated houses and communities and can be predictive of encounters with law enforcement and justice systems. Thus, lead can now be seen not only as a reversible neurotoxin, but as a cause of permanent intellectual and behavioral problems than have a significant social impact. Furthermore, when the individuals who have had adverse cognitive and behavioral consequences of lead toxicity become parents, there is an increased likelihood of child neglect and abuse; and, if this does occur, the children will be referred to the state services for vulnerable children. If neglect or abuse is validated, the children are likely to be taken out of their own homes and placed in foster care, which further complicates and compounds the developmental, emotional, and social function of the children.

It is important to note that there are a number of different developmental, behavioral, educational, social, emotional and health related factors that are associated with children and families who live in circumstances of social and economic disadvantage. (Table 1)

Table 1. Risk of Adverse Child Outcomes and Environmental Conditions Associated with Poverty Status

Child Outcomes / Risk for Poor Relative to Nonpoor Children

Lead poisoning / 3.5

Birth to unmarried teenager / 3.1

Short-stay hospital episode / 2.0

Grade repetition and high school dropout / 2.0

Low birth weight / 1.7

Mortality / 1.7

Learning disability / 1.4

Parent report of emotional or behavior problem that lasted 3 months or more / 1.3

SES Mediators

Child abuse and neglect / 6.8

Depression / 2.3

Experiencing violent crimes / 2.2

Substance abuse / 1.9

(Shonkoff & Phillips, 2000, p. 271).

Environmental Health Disparities

It has become increasingly clear that the environment in which a child grows and develops has a significant impact on the child’s health, development, and ultimate potential for success in life. The impact is a result of cumulative factors that consist of a genetic predisposition, adverse factors operating during pregnancy, factors operating in early childhood, family constellation and competence, coherence of the community, and on the ambient physical, chemical, economic, social, and political elements.

Some factors have been identified in determining increased environmental vulnerability are:

Limited educational opportunities affecting knowledge base, technical and language skills for the marketplace and therefore compromising employment opportunities

Limited social and political capital as far as empowerment and advocacy are concerned

Limited financial resources influencing options for where they can live and placing them at the mercy of the effects of a low tax base leading to limited community and social resources

The likelihood that there are increased level of environmental threats from toxins, physical infrastructural disrepair, and potential for violence

Significant stresses on individuals and families that compromise and complicate family life and can have a negative effect on physical, emotional, and social well-being

Suspicion and distrust of established authority figures further compromising opportunities for soliciting or inviting change

(Rubin, Nodvin, Geller, Teague, Holtzclaw, et al., 2007).

Conclusions

Environmental factors that affect the health and well-being of individuals, families and communities can be seen as operating at a number of different levels:

Communities and Neighborhoods – these factors look directly at the physical, chemical and infrastructural elements within the immediate environment

The Social and Cultural Context – these factors look more broadly at the prevailing social structure, culture and less tangible elements in an environment

Health Care Access – this is critically relevant to assuring appropriate preventive, interventional and therapeutic strategies for a variety of environmental threats

It is our responsibility as citizens and professionals to become aware of environmental factors that can affect the health and well-being of individuals, families and communities and what we can do advance the knowledge in our society to reduce risk and promote enhanced health and safety. In this way we can then strive to make positive changes in our environment for the better of humanity and life on this planet.

References:

Lutzker, J.R. & Campbell, R. (1994). Ecobehavioral family interventions in developmental disabilities. Pacific Grove, CA: Brooks/Cole.

Rubin, L., Nodvin, J., Geller, R.J., Teague, W.G., Holtzclaw, B., & Felner, E.I. (2007). Environmental health disparities: environmental and social impact of industrial pollution in a community – the model of Anniston, AL I. Pediatric Clinics of North America, 54, 375-398.

Schettler, T., Stein, J., Reich, F., Valenti, M., & Wallinga, D. (2000). In harm’s way: Toxic threats to child development. Cambridge, MA: Greater Boston Physicians for Social Responsibility.

Shonkoff, J.A. & Phillips, D.A. (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.

Other Resources

Chen, A., Cai, B., Dietrich, K.N., Radcliff, J. & Rogan, W.J. (2007). Lead exposure, IQ, and behavior in urban 5- to 7-year-olds: Does lead affect behavior only by lowering IQ? Pediatrics, 119(3) 650-658.

Lanphear, B.P., Dietrich, K.N., & Berger, O. (2003). Prevention of lead toxicity in US children. Ambulatory Pediatrics, 3(1) 27-36.

Lutzker, J.R. & Bigelow, K.M. (2002). Reducing child maltreatment: A guidebook for parent services. New York: Guilford Press.

Schettler, T., Solomon, G., Valenti, M., & Huddle, A. (1999). Generations at risk: Reproductive health and the environment. Cambridge, MA: MIT Press.

For further information, contact Dr. Rubin at lrubi01@emory.edu. The website of the Institute for the Study of Disadvantage and Disability is www.isdd-home.org.